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Biomedical subjects

D Blanco Bravo

Publications and source records attributed to D Blanco Bravo.

9 recordsLinked to original sources
PubMed2006

[Aortic and cerebral trombosis caused by hypernatremic dehydration in an exclusively breast-fed infant].

Complete aortic thrombosis is rare in neonates. Because it carries high morbidity and mortality, this entity requires aggressive and early treatment. This report describes an 8-day-old healthy and exclusively breast-fed infant, without specific coagulopathy, who developed complete aortic and cerebral venous thrombosis, which was attributed to inadequate breast-feeding and severe hypernatremic dehydration. Early systemic anticoagulation and thrombolytic therapy allowed complete resolution of the problem.

Anticoagulants↗
PubMed2001

[Recommendations for the care of healthy newborn infants].

This article makes certain recommendations on the care of the healthy newborn. Firstly, we discuss the situations that should be reported to the pediatrician/neonatologist and the reasons why the presence of these specialists is required in the delivery room (urgent or elective cesarean section, preterm labor). Secondly, we discuss the most important guidelines to follow in the delivery room and after birth. Concerning care in the delivery room, we stress the importance of care of the newborn (especially of the umbilical cord), bonding between the mother and child, identification of the newborn, assessment of neonatal adaptation to extrauterine life, prevention of ophthalmia neonatorum and hypoprothrombinemia, placing the baby correctly in the crib and hepatitis B prophylaxis. Concerning the postnatal period, we recommend feeding (promotion of breast feeding), rooming-in with the mother if the newborn is hospitalized in the nursery screening for hypoacousia and metabolic diseases, and discharge with special surveillance in cases of early discharge.

Delivery, Obstetric↗
PubMed2001

[Recommendations for perinatal transport].

Perinatal transport should be integrated into a system of perinatal care within a regional health care program and should be planned according to the healthcare map of each community. We describe the various types of transport, their advantages and disadvantages, the resources required, and the protocol that should be followed in perinatal transfer. We highlight the importance of maternal and neonatal transport. The organization of transfers receives special attention, and we discuss the different functions of the coordinating, referral and receiving centers as well as those of the transport assistance team. We also discuss ethical-legal questions.

Algorithms↗
PubMed1999

[Extracorporeal membrane oxygenation, ECMO. Experience with the first 22 cases].

OBJECTIVE: Extracorporal membrane oxygenation (ECMO) is an alternative to cases of respiratory or cardiopulmonary insufficiency when conventional therapy has failed. We present the first 22 patients treated with ECMO at the neonatology unit of the "Gregorio Marañon" Hospital. PATIENTS AND METHODS: From October 1997 until September 1999, 22 patients were treated with ECMO. In 8 of them ECMO was necessary because of respiratory insufficiency without response to conventional treatment (r-ECMO) and a veno-venous tidal flow system was used. In 14 patients, cardiac ECMO was necessary in the veno-arterial modality because of ventricular failure after extracorporal circulatory assistance during cardiovascular surgery. RESULTS: The 8 patients of the respiratory ECMO group had a mean previous oxygenation index of 89 +/- 36.6 (50-150). The mean duration of ECMO was 7.8 +/- 6.5 (1-16) days and the age at the beginning of ECMO ranged between 1 and 151 days. The most frequent indications in this group were congenital diaphragmatic hernia in three cases, meconium aspiration syndrome in 2 cases and 1 case each of septic shock, idiopathic pulmonary hypertension and air leak. The cannula was removed in 5/8 patients due to recovery and 5/8 survived. The 14 patients of the cardiac ECMO group needed veno-arterial ECMO because of severe ventricular failure. Eight out of fourteen were decannulated after improvement. In 5/14 there was multiorgan failure or bad neurological prognosis resulting in death while on ECMO. In 1 out of 14 patients removal of the cannula was impossible because of cardiac insufficiency. The mean age at the beginning of ECMO was 54 (3-178) days. The mean weight at ECMO was 3209 +/- 739 (2700-5000) gr and the mean duration of ECMO was 6 (1-15) days. CONCLUSIONS: ECMO is an effective treatment in rescuing critical patients when conventional treatment fails. Meconium aspiration syndrome is the pathology with the best prognosis on ECMO. Cardiac ECMO represents a complex group of patients in which ECMO is the only treatment and which may result in recovery in 40% of the patients.

Cardiac Output, Low↗
PubMed1993

[Balloon (Rashkind) atrio-septostomy in transposition of great vessels in the neonatal period].

Analysis of the balloon atrial septostomy (BA) for treatment of the transposition of the great arteries (TVG) during the neonatal period will allow the evaluation of some of the changes that have occurred in the diagnosis and therapy of this congenital cardiopathy. We performed a retrospective survey of the management, evolution complications of 24 BA as a palliative technique in TGV cases, admitted to the Neonatal Intensive Care Unit during a 5 1/2 year period. The aim of the study was to evaluate the factors that indicated a bad prognosis by comparing patients that are still alive (21) with those that are dead (3). The mean age at BA performance was 4.5 +/- 5.5 days. The biological constants prior to catheterization were normal, maintaining good oxygenation, administering prostaglandins in 80% of the patients and mechanical ventilation in 25% of the patients. BA outcome was considered as good in 68%, moderate in 12% and bad in 20% of the cases. Intra-catheterization complications, mainly hemorrhages and bradycardia, were suffered by 40% of the patients and one patient died during catheterization. We could see a progressive arterial desaturation due to the lack of efficacy of the BA. As bad post-catheterization outcome factors were found: hypotension, arrhythmia, hemorrhage, greater need of dobutamine, volume expansion and mechanical ventilation. Our principal conclusion is that, although BA has improved the prognosis of newborns with TGV, because of the progressive worsening of the patients during the months following the BA, it is necessary to perform early corrective surgery.

Catheterization↗
PubMed1993

[Perioperative management of systemic pulmonary shunts in the neonatal period].

We have analyzed 36 newborns (19 males and 17 females), with cyanotic cardiopathies in whom a systemic-pulmonary shunt had been performed. These patients were admitted to the Neonatal Intensive Care Unite between January 1985 and June 1990. We studied the perioperative events with the aim of describing the general features of this palliative surgery in the neonatal period and to determine the factors which indicate a bad prognosis. The age at admission was 10.5 +/- 16.5 days and at surgery was 19.5 +/- 20 days. Cardiopathy types included: 13 pulmonary atresias, 9 pulmonary stenoses, 6 D-transposition of the great arteries and 8 tetralogies of Fallot. Of these patients, 83% required prostaglandin administration before surgery. Cardiac catheterization was performed in 54% (in 1/3 balloon atrioseptostomy was performed). The mean diameter of the pulmonary branches was 3.5 +/- 0.7 mm. In 89%, a modified Blalock-Taussig shunt and in 11% a central aorto-pulmonary shunt were performed. The size of the prosthetic graft used was 4 mm in diameter in 77% of the cases, 5 mm in 20% and 3 mm in 3% of the patients. The mortality rate was 27% (intraoperative = 0%, early postoperative = 16%, late postoperative = 11%) with two critical periods: the initial 48 postoperative hours and the reoperation. Bad prognosis factors related to mortality are; preoperative (shorter gestational age and low newborn weight), operative (performance of a central aortopulmonary shunt, surgical ligation of the ductus during operation) and postoperative (arrhythmias, metabolic acidosis in the immediate postoperative period, lower oxygen saturation at 24 hours after the operation, hemorrhage). Our data are compared with other reports of systemic-pulmonary shunt in the neonatal period.

Aorta, Thoracic↗
PubMed1992

[The perioperative management of aortic coarctation in the neonatal period].

Clinical records of 30 neonates with aortic coarctation admitted to neonate ICU from January 1985 to June 1990 are reviewed. We analyzed perioperative data to search for adverse prognostic signs. Patients weights were 2,970 +/- 500 grams and gestational age 38.5 +/- 1.7 weeks. Mean age at admission was 10.5 +/- 10 and mean age of surgery 13 +/- 11 days. 70% had associated congenital heart defects. Surgical technique was patch angioplasty in 86% and subclavian flap in 14%. Early or late mortality among patients with isolated aortic coarctation was nonexistent, and it was 28.5% in patients with other congenital heart defects. 13% has postoperative hypertension and 3.3% recoarctation. Adverse prognosis signs were preoperative (associated congenital heart defects, especially ventricular septal defect and interrupted aortic arch, greater dose of catecholamines and mechanical ventilation), intraoperative (pulmonary artery banding), and postoperative (hypotension, cardiac failure, arrhythmia, oligoanuria, metabolic acidosis, greater need of mechanical ventilation, bleeding and thrombopenia). Date are compared with other neonatal series.

Aortic Coarctation↗